DHHS is Reprocessing 2019 Medicaid E&M Claims Due to CMS Rate Change

Primary care physicians serving Medicaid with E&M codes ranging from 99201 to 99499 as defined by the Affordable Care Act (ACA) are now being paid at an increased rate. CMS approved the rate increase effective Jan. 1st, 2019, thanks to the advocacy efforts of the NCAFP and the NC Pediatric Society. NC DHHS is re-processing all affected claims for these codes submitted between Jan. 1 and Sept. 3, 2019. The difference is being remitted in the Sept. 24th checkwrite. E&M codes that did not receive an increase are also still under review based on the State Plan Amendment criteria.